Neurovascular Injuries

The axillary nerve, musculocutaneous nerve, and brachial plexus are at risk during open surgery for anterior instability. Injuries may occur by excessive tissue retraction, especially retraction of the coracobrachialis, by direct laceration, or by suture entrapment. Fortunately, most are transient neurapraxias. Shoulder surgeons should be comfortable locating and isolating the axillary nerve, the musculocutaneous nerve, and the Brachial plexus, especially in revision settings.

Of all the procedures described, the Bristow and Latarjet procedures have the highest reported risk of injury to the axillary and musculocutaneous nerves. Revision surgery after a failed Bristow or Latarjet can be quite challenging and exposing the axillary nerve in such instances can be quite difficult in open posterior instability surgery.